"The wise, for cure, on exercise depend": physical activity interventions in primary care in Wales

Physical inactivity is an important public health problem, which could be addressed by health promotion initiatives in primary care. The interventions most widely available to primary care clinicians are advice/counselling and exercise referral. A review of four systematic reviews found that brief advice from a general practitioner, supported by written materials, has a modest short-term effect on physical activity lasting 6-12 months. Exercise referral schemes have been introduced throughout Wales and the rest of the UK. A systematic review and meta-analysis found that such schemes resulted in a statistically significant increase in the proportion of sedentary people becoming moderately active, but the absolute risk reduction was small, with 17 sedentary people needing to be referred for one to become moderately active. This small effect size could partly be explained by poor rates of uptake and adherence and was not likely to be an efficient use of resources. These findings were in concordance with the guidance from the National Institute for Health and Clinical Excellence, which states that schemes should only be recommended if they are part of a properly designed and controlled research study. Since 2007, a national exercise referral scheme is being rolled out throughout Wales in three phases, and is being evaluated in a pragmatic randomised controlled trial comparing exercise referral with an advice booklet.